Traslado a hospitalización convencional de pacientes atendidos en Hospitalización a Domicilio / Transfer to conventional hospitalization of patients treated in Hospitalization at Home

Introducción: La HaD evita la estancia en el hospital de pacientes proporcionándoles en su domicilio el mismo tratamiento y cuidados que se le prestarían en el hospital. En algunos casos esto no se consigue y las/os pacientes requieren el traslado a hospitalización convencional (THC). El objetivo del trabajo es analizar con qué frecuencia ocurre el THC, sus motivos y proponer un modelo de predicción basado en características de los pacientes que influencian el THC. Método: Estudio retrospectivo, multicéntrico, que aprovecha las características registradas en los pacientes atendidos en mayo de 2021 en 9 Servicios de HaD de Osakidetza-Servicio Vasco de Salud, completados con datos del alta (fecha y destino). Se comparó el porcentaje de THC no programado en pacientes con /sin diferentes variables binarias. Con las significativas se realizó una regresión logística binaria y a partir de sus resultados se construyó un modelo predictivo simplificado. Resultados: Se analizaron 1129 episodios de HaD de las modalidades de acortamiento o evitación de ingreso. 139 (12,3%) requirieron THC, que en 105 (9,3%) fue no programado (THCNP). 32 de estos fallecieron en el hospital y 44 retornaron a HaD. En función de la modalidad asistencial, el grupo de patología y la puntuación en test de Barthel, los pacientes se clasificaron en 3 grupos cuya frecuencia de THCNP fue de 3.4, 11.5 y 20.5 % respectivamente. Conclusiones: El THCNP de pacientes de H a D ocurre con frecuencia diferente en función de ciertas características de los pacientes y se puede predecir a partir de ellas. (AU)

Introduction: The Hospital at Home (HaH) modality of care avoids hospital stay for some patients by providing them with the same treatment and care at home as they would receive in the hospital. In some cases this is not achieved and patients require transfer to conventional hospitalization (THC). The aim of this work is to analyze how often THC occurs, the reasons for it and to propose a predictive model based on patient characteristics that influence THC. Method: Retrospective, multicentre study using the characteristics recorded in patients seen in May 2021 in 9 HaH Services of Osakidetza-Basque Health Service, completed with discharge data (date and destination). The percentage of unscheduled THC in patients with/without different binary variables was compared. A binary logistic regression was performed with those that were significant and a simplified predictive model was constructed from the results. Results: A total of 1129 HaH episodes of admission shortening or avoidance modalities were analysed. 139 (12.3%) required THC, which in 105 (9.3%) was unscheduled (THCNP). Of these, 32 died in hospital and 44 returned to HaH. According to the modality of care, pathology group and Barthel test score, patients could be classified into 3 groups with a THCNP frequency of 3.4, 11.5 and 20.5 % respectively. Conclusions: THCNP of patients seen in H to D occurs with different frequency depending on certain patient characteristics and can be predicted from them. (AU)

Descripción de actividad asistencial en las Unidades de Hospitalización a Domicilio de Osakidetza – Servicio Vasco de Salud / Description of care activity in the Hospital at Home Units of Osakidetza - Servicio Vasco de Salud (Basque Health Service)

Introducción: Las Unidades de Hospitalización a Domicilio (HaD) presentan diferencias en su contenido y condiciones de asistencia. La Sociedad Vasca de HaD inició en 2018 un proyecto de investigación para definir indicadores que permitan comparar la actividad de equipos que tienen contenidos asistenciales diferentes. Una fase del proyecto implicó el registro de características de los episodios atendidos y la atención prestada. Dar a conocer el resultado del registro es de interés.Método: Entre 1 y 31 de mayo de 2021, 9 Uni-dades registraron ciertas características de los pacientes atendidos, así como tipo, frecuencia y duración de las visitas realizadas. Se muestran los descriptivos de estas variables en la serie global y en cada Unidad.Resultados: Se analizaron 1171 episodios y 8363 visitas en 14458 estancias. (82% de es-tancias reales). De media, en laborable se vi-sitó al 65% de los pacientes y en no laborable al 42%. El porcentaje de casos en cada tipo clínico varió según Unidades: patología aguda entre 12 y 48%; cuidados paliativos entre 20% y 40%; patología quirúrgica entre 2.3 y 30 %. Se apreciaron también diferencias en edad, sexo y dispersión geográfica. Mortalidad y reenvío al hospital variaron entre Unidades y también entre patologías. La duración de la atención direc-ta varió entre Unidades entre 24,4 y 35.9 min, y la del desplazamiento para cada visita entre 11.9 y 25 min, en probable relación con el tipo de patología y la dispersión geográfica respectivamente.Conclusiones: Se constata que existen diferencias en el contenido y condiciones de trabajo de las distintas Unidades de H a D. Es necesario analizar cómo influyen en las medidas de actividad y de resultado para disponer de indicadores ajustados. (AU)

Introduction: Hospitalization at Home (HaH) Units present differences in their content and conditions of care. The Basque HaH Society initiated a research project in 2018 to define useful indicators to compare the activity of teams with different care content. One phase of the project involved recording characteristics of episodes attended and care provided. It is of interest to disclose the results of the registry. Method: Between May 1 and May 31, 2021, 9 Units recorded certain characteristics of the patients seen, as well as type, frequency and duration of visits performed. Descriptive data on these variables are shown for the overall series and for each unit. Results: 1171 episodes and 8363 visits in 14458 stays were analysed (82% of actual stays). On average, 65% of patients received a visit during working days and 42% during non-working days. The percentage of cases in each clinical type varied according to Units: acute pathology between 12 and 48%; palliative care between 20% and 40%; surgical pathology between 2.3 and 30%. There were also differences in age, sex and geographical dispersion. Mortality and hospital referral varied between Units and also between pathologies. The duration of direct care varied between Units from 24.4 to 35.9 min, and the duration of travel for each visit from 11.9 to 25 min, probably related to the type of pathology and geographical dispersion, respectively. Conclusions: There are indeed differences in the content and working conditions of the different HaH Units. It is necessary to analyse how much they influence the activity and outcome measures in order to have adjusted indicators. (AU)

Factors associated with the workload of health professionals in hospital at home: a systematic review.

BACKGROUND: Understanding the factors related to workload, could help hospital at home (HaH) managers to make decisions on the most appropriate and efficient use of the HaH services. Published studies on this topic are scarce, so we have conducted a systematic review to identify such factors according to published evidence. METHODS: Due to the heterogeneity of HaH models, HaH was defined as a care that provides a set of medical and nursing care and attention of hospital rank to patients at home, when they no longer require hospital infrastructure but still need active monitoring and complex care. The electronic data base literature search was conducted in MEDLINE (Ovid), EMBASE (Ovid), and Cinahl (EBSCOhost) from inception to December 2021, including grey literature. Search terms related to `hospital at home´, `workload´ and `care time´ were used. There was no restriction on language, type of study or year of publication. Quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist and certainty in the body of evidence was assessed using the GRADE Pro Tool. Results were summarised in a tabulated format. RESULTS: Eighteen studies with 56,706 patients were included. Workload was measured as time, number of visits or both. The predictive factors of the workload included variables related to patient characteristics and other valid and reliable patient classification systems, as well as characteristics of the institutions where the studies were conducted. The factors associated with higher workloads were: being older, male, living in a rural environment, presenting a higher number of diagnoses, having worse functional status and being unable to assume self-care. CONCLUSIONS: The identified predictors of workload are mostly associated with home nursing care. The results could be useful and applicable to different organisational models of HaH health systems. More studies that include physicians and proxy measures of workload are needed.

Derivación a hospitalización a domicilio de pacientes con infección por COVID-19 / Referral to home care of patients with COVID-19 infection

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Tratamiento de la neumonía adquirida en la comunidad en hospitalización a domicilio: resultado clínico en casos con diferente nivel de gravedad / Efficacy of hospital at home (HaH) in the treatment of community-acquired pneumonia (CAP) with different degrees of severity

Fundamento y objetivo: Diferentes sociedades científicas proponen el uso de escalas de severidad más otros criterios adicionales para determinar el lugar de tratamiento de la neumonía adquirida en la comunidad. El objetivo de este estudio es correlacionar el riesgo según 3 reglas de predicción clínica (PSI, CURB-65 y PSCURXO-80) y criterios adicionales con la efectividad de la hospitalización a domicilio (HaD).Pacientes y método: Revisión de los casos de neumonía adquirida en la comunidad remitidos por el servicio de urgencias a HaD entre enero de 2000 y mayo de 2008. Se clasifican según 3 escalas de riesgo y presencia de criterios adicionales y se analiza su asociación con la inefectividad de HaD durante el tratamiento.Resultados: Se admitieron 146 mujeres y 181 hombres (edad media=60,3 años). La media de estancia en HaD fue de 8,6 días. Dos pacientes murieron, 25 (7,7%) fueron reenviados a hospitalización convencional, 219 fueron dados de alta sin incidencias y 81 tras superar complicaciones. La HaD fue efectiva en el 92,3% de los pacientes. El porcentaje fue del 85% para PSI=IV o V sin o con CA, del 80% para CURB-65=2 y del 77,5% para valores entre 10–19 de PSCURXO-80. La eficacia de HaD se relaciona inversamente con la severidad.Conclusiones: La eficacia de HaD en el tratamiento de neumonía adquirida en la comunidad es menor en los pacientes con mayor gravedad definida por medio de diferentes escalas de predicción clínica, pero es eficaz en un elevado porcentaje de casos en los que está indicado el ingreso hospitalario (AU)

Background and objective: Different scientific societies propose the use of scales of severity and additional criteria (AC) in order to determine the setting for the treatment of Community-Acquired Pneumonia (CAP).The objective of this study is to correlate the risk regarding three clinical prediction rules (PSI, CURB-65 and PSCRUXO-80) and AC with the effectiveness of hospital at home (HaH). Patients and method: Evaluation of cases of CAP referred from the Emergency Unit to HaH between January 2000 and May 2008. They were classified regarding three risk scales and presence of AC and its association with the effectiveness of HaH during the treatment was analysed. Results: 146 women and 181 men were admitted, (mean age, 60.3 years). The average stay in HaH was 8.6 days. Two patients died, 25 (7.7%) were admitted to hospital, 219 progressed favourably throughout and 81 after overcoming complications. Hospital at Home was effective in 92.3% of total patients. The rate was 85% for those in PSI=IV or V with or without additional criteria; 80% for CURB-65=2 and 77.5% for a PSCURXO-80 score of 10–19. The effectiveness of HaH is inversely related to severity (AU)ConclusionsHospital a Home (HaD) is an effective and safe care option for many cases of CAP in which hospital admission is normally recommended on the basis of prediction rule scores or additional admission criteria

[Efficacy of hospital at home (HaH) in the treatment of community-acquired pneumonia (CAP) with different degrees of severity]. / Tratamiento de la neumonía adquirida en la comunidad en hospitalización a domicilio: resultado clínico en casos con diferente nivel de gravedad.

BACKGROUND AND OBJECTIVE: Different scientific societies propose the use of scales of severity and additional criteria (AC) in order to determine the setting for the treatment of Community-Acquired Pneumonia (CAP).The objective of this study is to correlate the risk regarding three clinical prediction rules (PSI, CURB-65 and PSCRUXO-80) and AC with the effectiveness of hospital at home (HaH). PATIENTS AND METHOD: Evaluation of cases of CAP referred from the Emergency Unit to HaH between January 2000 and May 2008. They were classified regarding three risk scales and presence of AC and its association with the effectiveness of HaH during the treatment was analysed. RESULTS: 146 women and 181 men were admitted, (mean age, 60.3 years). The average stay in HaH was 8.6 days. Two patients died, 25 (7.7%) were admitted to hospital, 219 progressed favourably throughout and 81 after overcoming complications. Hospital at Home was effective in 92.3% of total patients. The rate was 85% for those in PSI=IV or V with or without additional criteria; 80% for CURB-65=2 and 77.5% for a PSCURXO-80 score of 10-19. The effectiveness of HaH is inversely related to severity. CONCLUSIONS: Hospital a Home (HaD) is an effective and safe care option for many cases of CAP in which hospital admission is normally recommended on the basis of prediction rule scores or additional admission criteria.

Tratamiento del absceso hepático: nueva evidencia de la utilidad de la hospitalización a domicilio / Treatment of liver abscesses: new evidence of the usefulness of hospital at home

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'Hospital at home' care model as an effective alternative in the management of decompensated chronic heart failure.

AIMS: The 'Hospital at home' (HaH) model avoids hospital admission by transferring healthcare and treatment to the patient's home. We aimed to compare the effectiveness and direct healthcare costs of treating elderly patients with decompensated heart failure (HF) using HaH care vs. inpatient hospital care (IHC) in a cardiology unit. METHODS AND RESULTS: Eighty patients aged over 65 years who presented at the emergency department with decompensated HF were randomly assigned to IHC or HaH. All patients were studied for 1 year. Seventy-one patients completed the study, of these 34 were admitted to cardiology and 37 received HaH care. No significant differences were found in baseline characteristics, including comorbidity, functional status, and health-related quality of life. Clinical outcomes were similar after initial admission and also after the 12 months of follow-up. Death or re-admission due to HF or another cardiovascular event occurred in 19 patients in IHC and 20 in HaH (P = 0.88). Changes in functional status and health-related quality of life over the follow-up period were not significantly different. The average cost of the initial admission was 4502 +/- 2153 euro in IHC and 2541 +/- 1334 euro in HaH (P < 0.001). During 12 months of follow-up, the average expenditure was 4619 +/- 7679 euro and 3425 +/- 4948 euro (P = 0.83) respectively. CONCLUSION: Hospital at home care allows an important reduction in the costs during the index episode compared with hospital care, whilst maintaining similar outcomes with respect to cardiovascular mortality and morbidity and quality of life at 1 year follow-up.

[Home intravenous antibiotic treatment: a study in 515 patients]. / Antibioterapia intravenosa en domicilio. Estudio de 515 casos.

OBJECTIVE: To assess the effectiveness of therapy, type of infection, hospital department of origin and outcome of 515 cases of infection requiring home intravenous antibiotic therapy treated by the home care service. METHODS: The clinical records of patients undergoing intravenous antibiotic therapy through the home care service over a 6-year period were retrospectively reviewed. RESULTS: A total of 439 patients (244M/195F; mean age, 55.9 years, range 7-96) requiring 515 courses of home intravenous antibiotic therapy were reviewed. Mean duration of antibiotic therapy was 7.9 days (1-58). Urinary (42.3%) and respiratory infections (25.8%) were the most frequent indications for home treatment. Most patients were referred from the emergency room (50.5%) followed by the Internal Medicine Department (11.5%) and Oncology Department (11.1%). Ceftriaxone was the most widely prescribed antibiotic (41.8%) followed by aminoglycosides (35.3%) and glycopeptides (11.7%). In 49 cases electronic infusion pumps were used, with ceftazidime being the predominant antibiotic (32.7%) in these cases. Hospitalization was required in 7% of patients due to infectious disease-related complications. Clinical outcome was positive in 79% of the patients, with improvement in 90% of patients from the emergency room CONCLUSIONS: The advantages of home care services to provide home intravenous antibiotic therapy are evident. More than half of the patients were referred from the emergency room and 90% of these progressed well. The presence of medical and nursing staff qualified to handle infectious diseases is necessary, as well as continuing home care.

Antibioterapia intravenosa en domicilio. Estudio de 515 casos / Home intravenous antibiotic treatment: A study in 515 patients

Objetivo. Valorar la efectividad, tipo de infección, servicio de procedencia y pronóstico de 515 casos tratados con antibioterapia intravenosa en domicilio en una Unidad de Hospitalización a Domicilio (UHD). Métodos. Estudio retrospectivo de un período de 6 años de las historias clínicas de los pacientes ingresados en la UHAD que recibieron antibióticos intravenosos. Resultados. Se trataron 439 pacientes (244 hombres y 195 mujeres) que generaron 515 casos. La edad media fue de 55,9 (límites: 7-96 años). La duración media del tratamiento antibiótico intravenoso en domicilio fue de 7,9 días (límites: 1-58 días). La localización infecciosa más frecuente fue la urinaria (42,3%) seguida de la respiratoria (25,8%). El servicio de procedencia que más pacientes remitió fue urgencias (50,5%) seguido de medicina interna (11,5%) y oncología (11,1%). La ceftriaxona fue el antibiótico más utilizado (41,8%), seguido de los aminoglucósidos (35,3%) y glucopéptidos (11,7%). En 49 ocasiones se utilizaron bombas programables de perfusión, siendo el antibiótico más utilizado la ceftazidima (32,7%). El 7% reingresaron por causa infecciosa. El 79% fueron dados de alta por evolución favorable. El 90% de los pacientes procedentes de urgencias tuvieron una evolución favorable. Conclusiones. Las ventajas de la hospitalización a domicilio para desarrollar programas de antibioterapia intravenosa en domicilio son evidentes. Más de la mitad de los pacientes procedieron del servicio de urgencias con una evolución favorable del 90%. Es precisa la presencia de personal médico y de enfermería cualificado en el tratamiento de enfermedades infecciosas y una asistencia continuada en domicilio (AU)

Objective. To assess the effectiveness of therapy, type of infection, hospital department of origin and outcome of 515 cases of infection requiring home intravenous antibiotic therapy treated by the home care service. Methods. The clinical records of patients undergoing intravenous antibiotic therapy through the home care service over a 6-year period were retrospectively reviewed. Results. A total of 439 patients (244M/195F; mean age, 55.9 years, range 7-96) requiring 515 courses of home intravenous antibiotic therapy were reviewed. Mean duration of antibiotic therapy was 7.9 days (1-58). Urinary (42.3%) and respiratory infections (25.8%) were the most frequent indications for home treatment. Most patients were referred from the emergency room (50.5%) followed by the Internal Medicine Department (11.5%) and Oncology Department (11.1%). Ceftriaxone was the most widely prescribed antibiotic (41.8%) followed by aminoglycosides (35.3%) and glycopeptides (11.7%). In 49 cases electronic infusion pumps were used, with ceftazidime being the predominant antibiotic (32.7%) in these cases. Hospitalization was required in 7% of patients due to infectious disease-related complications. Clinical outcome was positive in 79% of the patients, with improvement in 90% of patients from the emergency room Conclusions. The advantages of home care services to provide home intravenous antibiotic therapy are evident. More than half of the patients were referred from the emergency room and 90% of these progressed well. The presence of medical and nursing staff qualified to handle infectious diseases is necessary, as well as continuing home care (AU)

[Treatment of congestive heart failure in the setting of hospital at home. Study of 158 patients]. / Tratamiento de la insuficiencia cardíaca en régimen de hospitalización a domicilio. Estudio de 158 pacientes.

BACKGROUND AND OBJECTIVE: Hospital at Home might become a suitable alternative to traditional hospital admissions for several exacerbated chronic diseases. Congestive heart failure represents an important workload at the hospital level. In this study we present the results of our experience with congestive heart failure patients attended in Hospital at Home regimen during the period 1999-2001. PATIENTS AND METHOD: In 1999 we initiated a program to refer patients with congestive heart failure to Hospital at Home care. The program was agreed by the departments of emergency, cardiology, internal medicine and hospital at home. During the period 1999-2001, 158 patients (mean age = 76) were attended. Ninety one (58%) were women. At the moment of admission, 103 patients (68%) were on functional status IV of the NYHA. RESULTS: On average, patient's stay on hospital at home was 12,8 days. One hundred and twenty three (78%) of them were discharged, 29 (18%) had to be referred back to conventional hospitalisation and six (4%) died. During the 90 days following the discharge from Hospital at Home, the number of visits to the emergency department and the rate of hospital admissions decreased significantly. CONCLUSIONS: Our data confirm Hospital at Home as a valid option to conventional hospital admission for the management of patients with congestive heart failure.

Tratamiento de la insuficiencia cardíaca en régimen de hospitalización a domicilio. Estudio de 158 pacientes / Treatment of congestive heart failure in the setting of hospital at home. Study of 158 patients

FUNDAMENTO Y OBJETIVO: La hospitalización a domicilio puede convertirse en una alternativa real a la hospitalización tradicional en enfermedades crónicas reagudizadas como la insuficiencia cardíaca, que representa una carga asistencial importante en el ámbito hospitalario. En este trabajo presentamos los resultados de nuestra experiencia en el período 1999-2001 en pacientes con insuficiencia cardíaca atendidos en régimen de hospitalización a domicilio. PACIENTES Y MÉTODO: En 1999 se inició un programa de derivación de los pacientes con insuficiencia cardíaca a un régimen de hospitalización a domicilio en el Hospital Txagorritxu de Vitoria-Gasteiz, consensuado entre los Servicios de Urgencias, Cardiología, Medicina Interna y Hospitalización a Domicilio. Durante el período 1999-2001 se atendió a 158 pacientes con una edad media de 75,8 años siendo 91 (57,6 por ciento) mujeres. En el momento de su ingreso 103 pacientes (65,2 por ciento) se encontraban en grado funcional IV de la New York Heart Association. RESULTADOS: La estancia media de los pacientes fue de 12,8 días. Se pudo dar de alta a 123 pacientes (77,9 por ciento), 29 (18,3 por ciento) reingresaron en el hospital y 6 (3,8 por ciento) fallecieron. Se objetivó un descenso significativo tanto del número de visitas a urgencias como de los ingresos hospitalarios en los 90 días siguientes al alta del Servicio de Hospitalización a Domicilio. CONCLUSIONES: Nuestros datos confirman la validez de la hospitalización a domicilio como alternativa al ingreso hospitalario de pacientes con insuficiencia cardíaca descompensada (AU)